Abstract
Purpose
The arterial baroreflex depends on the integrity of the afferent limb, which can be quantified using the baroreceptor’s sensitivity (BRS) during the Valsalva maneuver (VM). The aim of this study was to evaluate, using autonomic nervous system tests, the autonomic function in patients after a carotid artery angioplasty (CAS).
Methods
We evaluated the changes in blood pressure (BP) during the VM (Valsalva ratio, BRS, sympathetic indexes) in 41 patients with symptomatic, unilateral, internal carotid artery stenosis.
Results
The Valsalva ratio between the baseline and the post-procedural day (1.3 ± 0.1 vs 1.44 ± 0.3; P = 0.002) and the post-procedural day and a month later (1.44 ± 0.3 vs 1.3 ± 0.3; P = 0.0002) revealed significant differences. This was confirmed with a cardiovagal BRS test. However, the adrenergic BRS did not reveal any differences. Sympathetic indexes [BP fall (SI1) and recovery during phase 2 (SI2)] showed differences for the periods before and a day after the treatment (36.9 ± 18.0 vs 27.2 ± 21.4 and 7.1 ± 13.1 vs 3.0 ± 8.2, respectively; P = 0.004) and for SI1 a day and a month after the treatment (27.2 ± 21.4 vs 37.1 ± 21.8; P = 0.036). The dynamic ranges between S1 and S3 (the difference in the BP between the baseline and the end of phase 2) were also different (P = 0.007 and P = 0.044, respectively).
Conclusion
We found heterogeneous responses in the BP regulation obtained with the Valsalva maneuver in our patients; however, we could not confirm that CAS provoked any long-term autonomic dysfunction, except for 1 day after the procedure.
Similar content being viewed by others
References
Roffi M, Sievert H, Gray WA et al (2010) Carotid artery stenting versus surgery: adequate comparisons? Lancet Neurol 9:339–341
Brott TG, Hobson RW 2nd, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23
Coutts SB, Hill MD, Hu WY (2003) Hyperperfusion syndrome: toward a stricter definition. Neurosurgery 53:1053–1058
Karapanayiotides T, Meuli R, Devuyst G et al (2005) Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. Stroke 36:21–26
Bouri S, Thapar A, Shalhoub J et al (2011) Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg 41:229–237
van Mook WN, Rennenberg RJ, Schurink GW et al (2005) Cerebral hyperperfusion syndrome. Lancet Neurol 4:877–888
Canovas D, Estela J, Perendreu J et al (2012) Cerebral hyperperfusion syndrome after angioplasty. In: Forbes T (ed) Angioplasty, various techniques and challenges in treatment of congenital and acquired vascular stenoses. InTech, Rijeka, pp 9–40
Ogasawara K, Mikami C, Inoue T, Ogawa A (2004) Delayed cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy: case report. Neurosurgery 54:1258–1262
Ahn SS, Marcus DR, Moore WS (1989) Post-carotid endarterectomy hypertension: association with elevated cranial norepinephrine. J Vasc Surg 9:351–360
Timmers HJ, Wieling W, Karemaker JM, Lenders JW (2004) Baroreflex failure: a neglected type of secondary hypertension. Neth J Med 62:151–155
Cayne NS, Faries PL, Trocciola SM et al (2005) Carotid angioplasty and stent-induced bradycardia and hypotension: impact of prophylactic atropine administration and prior carotid endarterectomy. J Vasc Surg 41:956–961
Benarroch EE, Opfer-Gehrking TL, Low PA (1991) Use of the photoplethysmographic technique to analyze the Valsalva maneuver in normal man. Muscle Nerve 14:1165–1172
Denq J-C, O’Brien PC, Low PA (1998) Normative data on phases of Valsalva maneuver. J Clin Neurophysiol 15:535–540
von Reutern GM, Goertler MW, Bornstein NM et al (2012) Recommendations for grading carotid stenosis by means of ultrasonic methods. Stroke 43:916–921
Hamilton WF, Woodbury RA, Harper HT Jr (1936) Physiologic relationships between intrathoracic, intraspinal and arterial pressures. JAMA 107:853–856
LeWinter MM (2001) Normal physiology of the cardiovascular system. In: Fuster V, Alexander W, Wellens GJJ (eds) Hurst’s the heart, 10th edn. McGraw-Hill, Maidenheach, pp 63–94
Kjeldsen S, Feldman RD, Lisheng L et al (2014) Updated national and international hypertension guidelines: a review of current recommendations. Drugs 74:2033–2051
Low PA, Tomalia VA, Park KJ (2013) Autonomic function: some clinical applications. J Clin Neurol 9:1–8
Schrezenmaier C, Singer W, Muenter Swift N, Sletten D, Tanabe J, Low PA (2007) Adrenergic and vagal baroreflex sensitivity in autonomic failure. Arch Neurol 64:381–386
Vogel ER, Sandroni P, Low PA (2005) Blood pressure recovery from Valsalva maneuver in patients with autonomic failure. Neurology 65:1533–1537
Persson PB, DiRienzo M, Castiglioni P et al (2001) Time versus frequency domain techniques for assessing baroreflex sensitivity. J Hypertens 19:1699–1705
Novak P (2011) Assessment of sympathetic index from Valsalva maneuver. Neurology 76:2010–2016
Weston PJ, James MA, Panerai R et al (1996) Abnormal baroreceptor-cardiac reflex sensitivity is not detected by conventional tests of autonomic function in patients with insulin-dependent diabetes mellitus. Clin Sci (London) 91:59–64
Pitzalis MV, Mastropasqua F, Passantino A et al (1998) Comparison between noninvasive indices of baroreceptor sensitivity and the phenylephrine method in postmyocardial infarction patients. Circulation 97:1362–1367
Pickering TG, Gribbin B, Sleight P (1972) Comparison of the reflex heart rate response to rising and falling arterial pressure in man. Cardiovasc Res 6:277–283
Milic M, Sun P, Liu F et al (2009) A comparison of pharmacologic and spontaneous baroreflex methods in aging and hypertension. J Hypertens 27:1243–1251
Yakhou L, Constant I, Merle JC, Laude D, Becquemin JP, Duvaldestin P (2006) Noninvasive investigation of autonomic activity after carotid stenting or carotid endarterectomy. J Vasc Surg 44:472–479
Huang C-C, Wu Y-S, Chen T et al (2010) Long-term effects of baroreflex function after stenting in patients with carotid artery stenosis. Auton Neurosci 158:100–104
Bishop VS, Haywood JR, Shade RE, Siegel M, Hamm C (1986) Aortic baroreceptor deafferentation in the baboon. J Appl Physiol 60:798–801
Shade RE, Bishop VS, Haywood JR, Hamm CK (1990) Cardiovascular and neuroendocrine responses to baroreceptor denervation in baboons. Am J Physiol 258:R930–R938
Timmers HJ, Karemaker JM, Wieling W, Buskens FG, Lenders JW (2001) Arterial barroreflex function after unilateral carotid endarterectomy. Clin Auton Res 11:188–189
Mangin L, Medigue C, Merle JC et al (2003) Cardiac autonomic control during balloon carotid angioplasty and stenting. Can J Physiol Pharmacol 81:944–951
Gianaros PH, Jennings JR, Olafsson GB et al (2002) Greater intima-media thickness in the carotid bulb is associated with reduced baroreflex sensitivity. Am J Hypertens 15:486–491
Lábrová R, Honzíková N, Maděrová E et al (2005) Age-dependent relationship between the carotid intima-media thickness, baroreflex sensitivity, and the inter-beat interval in normotensive and hypertensive subjects. Physiol Res 54:593–600
Fisher JP, Kim A, Young CN et al (2009) Influence of ageing on carotid baroreflex peak response latency in humans. J Physiol 587(22):5427–5439
Acknowledgments
This work was partly supported by the Slovenian Research Agency under Grant P2-0095.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no financial or other conflicts of interest.
Rights and permissions
About this article
Cite this article
Švigelj, V., Šinkovec, M., Avbelj, V. et al. Simple cardiovagal and adrenergic function tests in carotid artery stenosis patients as a potential tool for determining a transient autonomic dysfunction. Clin Auton Res 25, 383–390 (2015). https://doi.org/10.1007/s10286-015-0316-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10286-015-0316-8